Treatment of the hyperextension tibial plateau fracture with suspend position and leverage reduction

Abstract

Objective To discuss the clinical characteristic and therapeutic strategy of the hyperextension tibial plateau fracture, and analyze thesuperiority of suspend position and leverage reduction. Methods Fifteen patients with an average age of 42.2 years old(range, 32-55 years;14 males,1 females)surgically treated from August 2006 to June 2017 were included. Traction and sufficient detumescence pre-operation, three-dimensional CT examination were used to clarify the site and the collapse degree of the fracture. Magnetic Resonance Imaging were used to verifythe injury of ligament. All the patients were adopt suspend position, anterolateral and medial incision and the leverage reduction method.The articular surface of tibial plateau were observed with arthroscope. Iliac bone were used for structural bone graft and allograft bone were used for non-structural bone graft. The collateral ligaments and meniscusshould be repaired in the meantime, while the cruciate ligaments would be reconstructed at second phase. Results Fifteenpatients underwent preoperative preparation for 7-14 d, with an average of 9.8 ±0.61 d. The operation was successfully completed. The operation time was between 90-160 minutes, with an average of 121 minutes. The intraoperative bleeding was 86±35ml. All cases were followed-up. All patients gained bone union during 12-16 weeks after operation, with an average of 13.5 weeks. No loosening or breakage of internal fixation and no refracture occured during follow-up.All achieved the anatomical reduction post operation with X-ray scan. No reduction of articular surface lostduring follow-up. There was no statistical difference-in contrast posterior slope angle and varus angle of tibialplateau at postoperation, 3 month, 6 monthand 12 month follow-up. At final follow-up, the knee joint function was evaluated. The joint was stable and the range of flexion and extension of knee joint were 0-140°. At 12 month after operation, the HSS (The Hospital for Special Surgery)score were 80-97, with an average of 89.47±1.27. TheLysholm score was 93-100, with an average of 95.40±0.67. The Rasmussen clinical evaluation score were 22-28, with an average of 24.93±0.54. Fivecases were excellent and 10 were good. The Rasmussen radiological evaluation were 14-18, with an average of 15.47±0.36. Two cases were excellent and 13 were good. Conclusion The hyperextension tibial plateau fracture is a kind of knee extension injury with the loss of the posterior slope angle of tibial plateau.Suspend position and leverage reduction are convenient for exposing operating areaandbeneficial to recover the articular surface, which can be applied for clinical use. Key words: Tibial fractures; Posture; Fracture fixation, internal